Mycoplasma pneumoniae (MP) is a major cause of respiratory infections in children and adolescents. COVID-19 pandemic control measures may have disrupted the respiratory microenvironment and increased the risk of co-infection associated with severe community-acquired pneumonia (CAP). Previous studies on MP co-infections were limited by small samples and lacked generalizability, with little evidence on MP-bacterial co-infection. This retrospective cohort study investigated co-infections and clinical severity in pediatric MP patients in Guangzhou. In this single-center retrospective cohort study, patients aged ≤ 18 years with confirmed MP infection were recruited from July 2023 to January 2024 in Guangzhou, China. Blood and/or respiratory specimens were collected for respiratory pathogen testing. Participants who completed testing for all 8 viral and 5 bacterial pathogens were included in the multivariable analyses. Multivariate logistic regression and negative binomial regression models were applied to investigate the co-infection patterns and clinical severity of MP infection. A total of 1499 patients (mean [SD] age: 6.39 [3.49], 50.7
Multidrug-resistant tuberculosis (MDR-TB) is a critical global health threat. Rifabutin (RFB) is active against some rifampicin (RIF)-resistant Mycobacterium tuberculosis strains, but genetic markers guiding RFB use remain unclear. This study aimed to identify determinants of RFB susceptibility using whole-genome sequencing (WGS) and Minimum inhibitory concentrations (MICs) testing. MICs for RFB were determined by broth microdilution according to CLSI M24–A2 guidelines (susceptibility defined as MIC < 0.5 µg/mL) for 183 MDR-TB isolates from Shenzhen, China. Associations of rpoB mutations, lineage, and compensatory mutations with log2 transformed RFB MIC were assessed using Kruskal-Wallis tests, Fisher’s exact tests, and multivariable linear regression models. rpoB mutation type was the primary determinant of RFB susceptibility. D435V was consistently associated with preserved RFB susceptibility, with 66.7
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a critical global antimicrobial resistance threat, yet continental-level synthesis of its epidemiology in Africa remains limited. Reported prevalence varies markedly across African settings, raising concern that pooled estimates may obscure substantial heterogeneity driven by outbreak amplification, methodological diversity, and uneven surveillance capacity. We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines to estimate CRKP prevalence in Africa while evaluating between-study heterogeneity, methodological influences, and bloodstream infection (BSI)–specific burden. Electronic databases were searched from 2010 to 2026. The review protocol was prospectively registered in PROSPERO (CRD420261390170). Studies reporting species-specific CRKP prevalence from African clinical settings were included. Random-effects meta-analysis using Freeman–Tukey transformation with Hartung–Knapp adjustment was performed, with additional binomial–normal (logit) modelling to address extreme proportions (0
Chimeric antigen receptor (CAR) T-cell therapy has demonstrated remarkable efficacy in B-cell malignancies and autoimmune diseases. However, on-target depletion of normal B cells via CD19/B-cell maturation antigen (BCMA) targeting frequently leads to secondary hypogammaglobulinemia, substantially increasing the risk of opportunistic infections. Campylobacter coli bloodstream infection presenting as refractory cellulitis in this setting has rarely been documented. We report a middle-aged female with a history of immune thrombocytopenia (ITP) who received CAR-T cell therapy in a clinical trial and subsequently developed severe hypogammaglobulinemia (IgG < 2 g/L). Her ITP entered complete remission after CAR-T therapy (platelet count 362 × 10⁹/L at this hospitalization). Two months after CAR-T infusion, she presented with persistent bilateral lower limb cellulitis and recurrent fever despite multiple courses of broad-spectrum antibiotics over a period of more than two months (levofloxacin, cefoperazone-sulbactam, and clindamycin). Immunological workup revealed profound B-cell aplasia (0
To formulate control strategies and understand the prevalence of HIV-1 pretreatment drug resistance (PDR), this study investigated the characteristics of viral genotype distribution and PDR prevalence and associated factors in Yunnan Province, China, a key HIV-endemic region. In 2022, 399 individuals initiating or re-initiating antiretroviral treatment in Yunnan Province were surveyed using the probability proportional to size (PPS) sampling method. Viral RNA was extracted, amplified, and sequenced in the pol gene region. The characteristics of the distribution of HIV-1 genotypes and drug-resistant mutations were analyzed. Of the 377 pol sequences obtained, 17 HIV-1 genotypes were identified. The most common strains were CRF08_BC (48.0
The global incidence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) has surged in recent decades, establishing it as a formidable challenge in respiratory medicine. Despite its escalating clinical burden, current diagnostic approaches—primarily reliant on microbiological culture and species identification—remain constrained by prolonged turnaround times (3–6 weeks) and limited sensitivity. To address this critical gap, we aimed to identify and validate peripheral blood mRNA signatures as non-invasive diagnostic biomarkers for NTM-PD. We recruited 28 participants in the discovery phase, comprising 8 patients with Mycobacterium abscessus (MAB)-PD, 8 patients with Mycobacterium avium complex (MAC)-PD, and 12 age/sex-matched healthy controls (HC). Peripheral blood samples from all participants underwent bulk RNA sequencing and single-cell transcriptome sequencing (scRNA-seq). Hub genes prioritized through integrated bioinformatics analysis were subsequently validated in an expanded validation cohort of 50 NTM- PD patients (23 MAC-PD, 27 MAB-PD) and 35 HC using quantitative reverse transcription PCR (RT- qPCR). Finally, we assessed the correlation between hub gene expression levels and clinical parameters. Transcriptomic profiling revealed significant upregulation of eight core genes (IFIT1, IFI44L, GBP5, FOLR3, LY6E, IFITM1, S100A8, S100A12) in NTM-PD patients compared to healthy controls (P < 0.05). Among these, four genes exhibited the most pronounced differential expression: IFIT1 (P = 0.005), IFITM1 (P = 0.001), S100A12 (P < 0.001) and GBP5 (P = 0.001). Importantly, these four hub genes demonstrated consistent discriminatory power across both Mycobacterium avium complex (MAC)-PD and M. abscessus (MAB)-PD subtypes. Single-cell transcriptomic analysis further confirmed that these hub genes were predominantly upregulated in monocyte/macrophage and neutrophil subpopulations, validating the bulk-level findings at cellular resolution. Receiver operating characteristic (ROC) curve analysis further identified the triple-gene panel (IFITM1 + S100A12+GBP5) as the optimal diagnostic signature, achieving an area under the curve (AUC) of 0.85 with 84
Typhoid fever remains a major public health challenge in low-income countries, where surgical complications particularly ileal perforation account for the greatest share of associated mortality. In Niger, restricted access to bacteriological investigations leads to substantial under recognition of the true disease burden. To describe the epidemiological, clinical, therapeutic, and outcome characteristics of presumed typhoid ileal perforations managed surgically in two referral hospitals in Niger, and to identify factors independently associated with in-hospital mortality. A multicentre retrospective descriptive study was conducted at the Zinder National Hospital (ZNH) and the Maradi Regional Hospital Centre (RHC/M) between January 2014 and December 2019. All patients who underwent surgery for acute peritonitis secondary to presumed typhoid ileal perforation, defined on the basis of epidemiological, clinical, and intraoperative criteria, were included. Factors associated with in-hospital mortality were identified by multivariate logistic regression. A total of 2,931 cases of presumed typhoid ileal perforation were recorded among 4,271 operated acute peritonitis cases (68.6
Effective surveillance of respiratory infectious diseases is crucial for precise prevention and evidence-based public health response. This study analyzed the etiological spectrum of respiratory pathogens in Zhuhai, a high-mobility port city, from January 2024 to December 2025. Throat swab specimens from national sentinel influenza-like illness (ILI) cases and hospitalized severe acute respiratory infection (SARI) cases were tested for 22 pathogens using real-time PCR. Descriptive epidemiological methods were applied. Among 2,788 patients, the overall pathogen positivity rate was 64.56
In previously vaccinated older adults, SARS-CoV-2 breakthrough infection induces hybrid immunity, but SARS-CoV-2-specific IgG antibodies may still decline rapidly. Longitudinal serum proteomic correlates of rapid IgG waning in older adults remain insufficiently characterized. In a nested case-control study within the Yichang COVID-19 Antibody Longitudinal Survey (YC-CALS) cohort, 67 previously vaccinated elderly participants with monotonic SARS-CoV-2-specific IgG decline after breakthrough infection were included: slow decliners (n = 33) and rapid decliners (n = 34). None received additional COVID-19 vaccination during serological follow-up. Serum proteomics was performed on March and October 2023 samples. Linear mixed-effects models, adjusted for age, sex, BMI, and comorbidities, were used to identify candidate dynamic and endpoint proteins. Baseline proteomic profiles and clinical characteristics were then used for exploratory Lasso-based feature selection and internally cross-validated classification modelling. Rapid decliners were older and showed distinct longitudinal proteomic trajectories. Thirteen candidate dynamic proteins, including IGHA1, AZGP1, SERPINA1, and C9, showed significant group-by-time interaction signals and were enriched in complement activation, coagulation cascades, humoral immunity, and serine protease inhibitor activity. Baseline modelling identified 14 Lasso-selected protein features. In exploratory internal cross-validation, the neural network model showed the highest discrimination among the algorithms evaluated (AUC = 0.872), and SHAP analysis highlighted C1QB, GRN, AZGP1, and CFHR4 as major contributors. Longitudinal serum proteomics suggests that rapid hybrid immunity-associated IgG waning after breakthrough infection in elderly adults is associated with complement-coagulation activity and sustained innate immune activation. Baseline proteomic signatures may provide hypothesis-generating candidate biomarkers for future externally validated risk-stratification studies. Clinical trial number: not applicable.
Understanding antimicrobial prescribing practices is a prerequisite for developing effective antimicrobial stewardship programs. A comprehensive analysis of point-prevalence studies of antimicrobial prescribing among hospitalised patients in the Middle East Region is currently lacking. To determine the pooled point-prevalence of antimicrobial prescribing among hospitalised patients in the Middle East Region, and to assess the indications, classes and types of antimicrobial agents prescribed. In addition, this study evaluated the quality indicators of antimicrobial prescribing. This systematic review and meta-analysis adhered to the PRISMA 2020 Statement. Electronic bibliographic search was conducted on PubMed, Scopus and Google Scholar using antimicrobial/antibiotic prescribing, antimicrobial/antibiotic use, point-prevalence and the names of countries in the Middle East as search terms. Primary literature published in English language describing the point-prevalence and types of antimicrobial prescribing in inpatients from the inception of the databases to December 2025 were included. Data were synthesised using qualitative and quantitative methods. RevMan version 5.4 was used for a random-effect meta-analysis. Thirty-one eligible studies out of 1515 identified studies were included with most studies conducted in Saudi Arabia (n = 7) and Turkey (n = 6). The pooled point-prevalence of antimicrobial prescribing was 58.6
Community-acquired pneumonia (CAP) remains a common cause of hospitalization in the United Arab Emirates (UAE). Although well-established international clinical guidelines for CAP are available, antimicrobial prescribing practices continue to vary. This variation may contribute to inappropriate antibiotic use and the growing threat of antimicrobial resistance. Antimicrobial stewardship programs (ASPs) are shown to improve the quality of antimicrobial prescribing and reduce unnecessary antibiotic exposure. A core component of these programs is post-prescription review, which allows for the assessment of antimicrobial therapy based on clinical guidelines and patient’s clinical response. However, evidence evaluating the impact of post-prescription review on the management of CAP in the UAE is limited. This study aimed to assess temporal changes in the appropriateness of antimicrobial therapy following the implementation of a post-prescription review process in adults hospitalized with CAP. This study was conducted using a single-center, quasi-experimental interrupted time series design at a 200-bed tertiary care hospital in Dubai. The study period extended from July 2021 and June 2023. Adult patients aged 18–65 years admitted with CAP were included. Therapeutic appropriateness, assessed across antimicrobial selection, dosing, and duration, was the primary outcome. Length of hospital stay was evaluated as a secondary clinical outcome. Acceptance of clinical pharmacist recommendations during post-prescription review was also analyzed. Post-prescription review was associated with a significant increase in overall therapeutic appropriateness from 24.4
Central venous catheters are associated with a high risk of catheter-related bloodstream infection (CRBSI). Although multiple preventive strategies have been proposed, their comparative efficacy remains unclear. We aimed to systematically quantify the effects of infection-control interventions for preventing CRBSI in adult intensive care unit (ICU) patients with central venous catheters. This systematic review and meta-analysis follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, Cochrane, and CINAHL were searched for articles published between January 2000 and August 2025. Only randomized controlled trials involving adult ICU patients with central venous catheters were included. The primary outcome for quantitative synthesis was CRBSI, defined as bloodstream infection with evidence supporting catheter-relatedness according to original trial definitions. Secondary analyses were prespecified subgroup analyses of CRBSI according to intervention type and catheter-related technology subtype. Study quality was assessed using the Cochrane Risk of Bias 2.0. Random-effects meta-analysis was used to estimate pooled odds ratios with 95
Strongyloidiasis is caused by a parasitic worm, primarily Strongyloides stercoralis. In rural settings of Côte d’Ivoire, parasitological surveys have revealed that the prevalence of S. stercoralis infection can reach up to 50
Norovirus is a leading global cause of acute gastroenteritis (AGE), yet comprehensive data on its disease and economic burden across all age groups requiring medical consultation in China remains scarce, hindering evidence-based public health strategy formulation. A multi-center retrospective study was conducted on 23,527 AGE patients who underwent norovirus testing at medical institutions in four Chinese provinces between 2018 and 2024. The logistic regression models were used to analyze the related factors with norovirus infection rates, hospitalization risks, complication incidence, and direct medical costs. National annual direct medical burden of norovirus infection was estimated by combining study data with national population census and epidemiological survey data. The overall norovirus positive rate was 18.80
Necrotizing soft tissue infections (NSTIs) are surgical emergencies. While bacteria are the most common cause, invasive fungal infections like mucormycosis must be considered following severe trauma. Mucor circinelloides is an infrequent cause of fulminant infection in immunocompetent hosts compared to other Mucorales. This report details a challenging case of post-traumatic M. circinelloides mucormycosis in an otherwise healthy 55-year-old male. Following a severe crush injury to the right lower leg, the patient developed rapidly progressing tissue necrosis and septic shock despite standard management. Key clinical signs included disproportionate pain, extensive black eschar, and vascular thrombosis. Direct microscopy of debrided tissue revealed ribbon-like, pauciseptate hyphae, prompting a diagnosis of mucormycosis. Culture and whole-genome sequencing (WGS) identified the pathogen as M. circinelloides. Despite standard-dose liposomal amphotericin B and repeated debridement, the infection ultimately required a life-saving transtibial amputation; the patient subsequently recovered. This case adds to the evidence that M. circinelloides can cause devastating disease in healthy individuals. A triad of urgent microscopy, aggressive surgical debridement, and prompt antifungal therapy is critical. Clinicians must maintain a high index of suspicion for angioinvasive fungi when tissue necrosis is disproportionate to the injury, regardless of the patient’s immune status. Not applicable.
Sepsis is a complex, life-threatening syndrome associated with multiple organ dysfunction and high mortality. Patients with sepsis admitted to the intensive care unit (ICU) are at risk of various complications, among which venous thromboembolism (VTE) is one of the most common and severe. Traditional risk assessment tools have limited effectiveness in sepsis patients. In recent years, machine learning has been used to improve prediction accuracy in healthcare. Therefore, this study aims to develop a machine learning-based approach to better predict the risk of VTE in ICU sepsis patients. Data from ICU sepsis patients were retrospectively collected from the clinical database of the First Affiliated Hospital of Wenzhou Medical University (FAHWMU). Patients from 2021 to 2023 were divided into a training cohort (70
Artificial intelligence (AI) has shown substantial potential in tuberculosis (TB). However, physicians’ distrust of “black-box” algorithms remains a major barrier to clinical adoption. Although explainable AI (XAI) has emerged to enhance transparency, limited evidence exists regarding TB physicians’ specific needs for AI explainability in high-uncertainty infectious disease contexts. A qualitative descriptive study was conducted between November 2025 and January 2026 in Hubei Province, China. 26 TB physicians participated in semi-structured interviews. Data were analyzed using an inductive-deductive thematic analysis approach. Coding was conducted independently by two researchers and refined through iterative discussion until thematic saturation was reached. Five overarching themes emerged, including global explanations, local explanations, case-based explanations, mixed visual-text presentation formats, and implementation considerations. Physicians emphasized the importance of exclusionary explanations to support differential diagnosis and preferred concise, multimodal outputs aligned with clinical workflows. Optional access to detailed information was favored to reduce cognitive burden. Seamless system integration, institutional financial support, and robust data security were considered essential for AI adoption. XAI in TB extends beyond algorithmic transparency and functions as cognitive support for differential reasoning and trust calibration. User-centered, context-sensitive AI explanation design and supportive institutional policies are critical to ensuring responsible and effective integration of AI into infectious disease practice.
Identifying the causative pathogen is essential for selecting optimal antimicrobial therapy, and nanopore amplicon sequencing is an emerging approach for rapid nucleic acid based pathogen detection. This study reports clinical cases in which nanopore sequencing was used alongside conventional culture of clinical specimens obtained from infection sites, aiding clinical decision-making. From July 2024 to October 2025, eight patients with various infectious diseases were enrolled. All patients had at least one underlying disease, and their clinical diagnoses varied, including brain abscess, osteoarticular infection, pneumonia, and skin infection. Specimens, including abscess, ligament, intervertebral disc, joint fluid, sputum, and skin, were collected from infection sites for both routine culture and nanopore sequencing. Conventional cultures yielded no organisms in any of the clinical specimens. Nanopore sequencing was performed using the MinION device, and generated reads were analyzed through the EPI2ME platform. Nanopore amplicon sequencing identified pathogens in culture-negative infections, revealing fungi in three patients and bacteria in five. Targeted antimicrobial therapy based on sequencing led to clinical improvement in all cases. This case series demonstrates the potential utility of nanopore sequencing for detecting pathogens in culture-negative infections. Nanopore sequencing may inform treatment decisions when cultures are negative or are confounded by antibiotics.
Hepatitis B virus (HBV) remains a major driver of chronic liver disease (CLD), cirrhosis, and hepatocellular carcinoma (HCC) in sub-Saharan Africa. Patients with established CLD represent a high-risk group; acute or superimposed HBV infection in these individuals can trigger rapid hepatic decompensation, accelerate structural progression to cirrhosis, and elevate the lifetime risk of neoplastic transformation. Despite this vulnerability, clinical insights into its burden and specific risk profiles in public healthcare delivery networks remain poorly defined. To assess the prevalence and associated factors of HBV infection among chronic liver disease patients attending public referral hospitals in Bahir Dar, Ethiopia. A facility-based, cross-sectional study was conducted from October 2023 to January 2024 among 320 CLD patients across three public referral hospitals in Bahir Dar. Data were gathered through structured questionnaires, physical evaluations, and chart reviews. Bivariable and multivariable logistic regression analyses were utilized to compute adjusted odds ratios (AORs). To complement the odds ratio estimates in this high-prevalence setting (41.9
To evaluate the association of oral nutritional supplementation on nutritional, immune, and bacteriological outcomes in hospitalized patients with tuberculosis (TB) and malnutrition. This retrospective real-world study included 118 inpatients aged 18–90 years with TB and malnutrition. Of these, 78 received general dietary advice without oral nutritional supplementation, and 40 received a high-protein mixed-nutrient formula providing an additional 15 g of protein and 240 kcal daily. Changes in nutritional, immune, and sputum outcomes were evaluated using generalized estimating equations. Oral nutritional supplementation was associated with consistent improvements in nutritional and immune parameters, including albumin, prognostic nutritional index, neutrophil count, T-cell subsets (CD3+, CD4+, CD8+), as well as a greater reduction in the platelet-to-lymphocyte ratio and lower odds of immune dysfunction (OR = 0.14, 95
